Oncology Services Spec 1

Carle Health•Urbana, IL

1d•$20 - $33

About The Position

The Cancer Services Specialists is responsible for all the pre-authorizations and insurance inquiries within the cancer center. Understands payment denials and how to prevent denials to reduce losses; works and appropriately appeals the denials from insurance companies. The Cancer Services Specialist coordinates all cancer conferences/tumor boards at CCI-Urbana and CCI-Normal. They are responsible for ensuring all standards for CoC and NAPBC accreditations are met; tracking and entering data into the survey portal, coordinating and maintaining regular meetings of cancer committee and subcommittee and taking minutes. Cancer Services specialist play a key role in accreditation survey prep and reporting.

Requirements

Healthcare Work Experience

Nice To Haves

Certifications
Education

Responsibilities

Assumes primary responsibility in working with the third party payer for screening and authorizations for appropriate criteria/pre-certs/third party approvals
Obtains, documents, verifies and conducts follow-up on insurance authorizations and insurance eligibility as required for scheduled exams
Checks insurance eligibility to ensure that the information provided matches the insurance carrier's database information
Prepares written communication to notify appropriate staff of authorization updates and/or changes for insurance carriers
Interacts with external customers to inform and educate regarding authorization procedures
Manages and resolves denied cases. In cooperation with Billing Department, works denials by sending appeal letters and making appropriate contact with insurance companies or billing staff
Generates timely and compliant denial letters and to facilitate the submission of appropriate appeal documentation
Provides recommendations for policy and procedure changes to management to prevent or limit denials
Reviews and ensures diagnostic, ICD-10, and CPT code is utilized for ordering and pre-authorizations
Schedules, prepares, and coordinates Administrative Cancer Committee Meetings, cancer conferences, and meetings.
Assists with generating reports and gathering data for providers and staff in relation to accreditation activities.
Maintains ongoing cancer conference case lists and distributes to attendees in a timely manner.
Tracks cancer conference discussion to ensure all required elements are discussed for reporting to American College of Surgeons.